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Breast shaping video

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Getting a deeper latch with breast/chest shaping

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By Kelly Bonyata, BS, IBCLC

To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works...
For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.
In the Beginning...

Endocrine (Hormonal) Control of Milk Synthesis - Lactogenesis I & II

Milk production doesn't start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven - this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

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During the latter part of pregnancy, the breasts are making colostrum, but high levels of progesterone inhibit milk secretion and keep the volume "turned down". At birth, the delivery of the placenta results in a sudden drop in progesterone/estrogen/HPL levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels cues Lactogenesis II (copious milk production). Other hormones (insulin, thyroxine, cortisol) are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Lactogenesis II commences approximately 30-40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk "coming in") until 50-73 hours (2-3 days) after birth.

These first two stages of lactation are hormonally driven - they occur whether or not a mother is breastfeeding her baby.

Established Lactation...

Autocrine (Local) Control of Milk Synthesis - Lactogenesis III

After Lactogenesis II, there is a switch to the autocrine (or local) control system. This maintenance stage of milk production is also called Lactogenesis III. In the maintenance stage, milk synthesis is controlled at the breast - milk removal is the primary control mechanism for supply. Milk removal is driven by baby's appetite. Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.

By understanding how local/autocrine control of milk synthesis works, we can gain an understanding of how to effectively increase (or decrease) milk supply.

What does current research tell us about milk production?

Current research suggests that there are two factors that control milk synthesis:

Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) - the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).

The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites - thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through - thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.

Both of the above factors support research findings that tell us:

FULL
Breast
=
SLOWER
Milk
Production

EMPTY
Breast
=
FASTER
Milk
Production

Research indicates that fat content of the milk is also determined by how empty the breast is (emptier breast = higher fat milk), rather than by the time of day or stage of the feed.

How does milk supply vary throughout the day?

Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses. Fat content tends to increase as the day progresses (Hurgoiu V, 1985). These observations are consistent with current research if we assume the researchers were observing babies with a fairly typical nursing pattern, where baby has a longer sleep period at night and gradually decreases the amount of time between nursing as the day progresses.

Storage capacity: Another factor that affects milk production and breastfeeding management is mom's milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby's growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby's appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

Think of storage capacity as a cup - you can easily drink a large amount of water throughout the day using any size of cup - small, medium or large - but if you use a smaller cup it will be refilled more often.

What does the research tell us about increasing milk supply?

Milk is being produced at all times, with speed of production depending upon how empty the breast is. Milk collects in mom's breasts between feedings, so the amount of milk stored in the breast between feedings is greater when more time has passed since the last feed. The more milk in the breast, the slower the speed of milk production.

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings:

EMPTY
Breast
=
FASTER
Milk
Production

In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.

To accomplish this goal and increase milk production:

Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)

Empty the breasts as thoroughly as possible at each nursing/pumping session.

To better empty the breasts:

Make sure baby is nursing efficiently.

Use breast massage and compression.

Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.

Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Are you having problems with oversupply?

Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by "block nursing" - mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby's nursing frequency is not limited.

See also:
Frequently Asked Questions about Milk Production I'm confused about foremilk and hindmilk - how does this work?
Anatomy of the human breast. Diagram by DT Ramsay, RL Hartmann, PE Hartmann

Note: the graphics above are copyrighted. Do not use without express written permission.

Many thanks to Denise Fisher of Health e-Learning for the valuable feedback!

Additional information

How the breasts make and deliver milk from AskDrSears.com

Examining the Evidence for Cue Feeding Breastfed Infants by Lisa Marasco, BA, IBCLC and Jan Barger, MA, RN, IBCLC

Human Milk and Lactation by Carol L Wagner, MD

References

Cox DB, Kent JC, Casey TM, Owens RA, Hartmann PE. Breast growth and the urinary excretion of lactose during human pregnancy and early lactation: endocrine relationships. Exp Physiol. 1999;84(2):421-34.

Cox DB, Owens RA, Hartmann PE. Studies on Human Lactation: The Development of the Computerized Breast Measurement System. June 1998. Accessed May 28, 2004.

Cox DB, Owens RA, Hartmann PE. Blood and milk prolactin and the rate of milk synthesis in women. Exp Physiol. 1996 Nov;81(6):1007-20.

Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume and duration between feeds in women breastfeeding their full-term infants over a 24 h period. Exp Physiol. 2002 Mar;87(2):207-14.

Hartmann PE, Prosser CG. Physiological basis of longitudinal changes in human milk yield and composition. Fed Proc. 1984 Jun; 43(9): 2448-53.

Hurgoiu V, Marcu A, Sopon E, Olariu M. Dynamics of the composition of lipids in human milk during lactation. [French]. Pediatrie. 1985 Apr-May;40(3):201-5.

Ingram J, Woolridge M, Greenwood R. Breastfeeding: it is worth trying with the second baby. Lancet. 2001 Sep 22;358(9286):986-7.

Marasco L, Barger J. Cue Feeding: Wisdom and Science. Breastfeeding Abstracts. 1999 May;18(4):28-29

Mohrbacher N. Breastfeeding Answers Made Simple. First Edition. Amarillo, Texas: Hale Publishing; 2010. 390-401.

Neville MC, Morton J. Physiology and endocrine changes underlying human lactogenesis II. J Nutr. 2001 Nov; 131(11): 3005S-8S.

Neville MC. Anatomy and physiology of lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 13-34.

Neville MC, Morton J, Umemura S. Lactogenesis. The transition from pregnancy to lactation. Pediatr Clin North Am. 2001 Feb; 48(1): 35-52.

Peaker M, Wilde CJ. Feedback control of milk secretion from milk. J Mammary Gland Biol Neoplasia. 1996 Jul;1(3):307-15.

Perez-Escamilla R, Chapman DJ. Validity and public health implications of maternal perception of the onset of lactation: an international analytical overview. J Nutr. 2001 Nov;131(11):3021S-4S.

Ramsay DT, Kent JC, Owens RA, Hartmann PE. Ultrasound imaging of milk ejection in the breast of lactating women. Pediatrics. 2004 Feb;113(2):361-7.

Walker M. Physiology of the Breast During Pregnancy and Lactation. In: Walker M, editor. Core Curriculum for Lactation Consultant Practice, Sudbury, Massachusetts: Jones and Bartlett; 2002. 27-34.

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How does milk production work? * KellyMom.com

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To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works... For the most part, milk production is a "use it or lose it" process. The more often and effectively your baby nurses, the more milk you will make.

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For premature babies, mother's milk is like a medicine. Any infant formula these babies receive increases their risk of serious illness, so these mothers were under a lot of pressure to pump enough milk to meet their babies' needs.

Amazingly, when these mothers used their hands as well as their pump to express milk, they pumped an average of 48 percent more milk than the pump alone could remove. According to another study, this milk also contained twice as much fat as when mothers used only the pump. According to previous research, in most mothers exclusively pumping for premature babies, milk production falters after three to four weeks. But the mothers using this "hands-on" technique continued to increase their milk production throughout their babies' entire first eight weeks, the entire length of the study.

Hands-on pumping is not just for mothers with babies in special care. Any mother who pumps can benefit from it. How does it work? For a demonstration of this technique, watch the online video "How to Use Your Hands When You Pump" HERE. As a summary, follow these steps:

1. Massage both breasts.

2. Double pump, compressing your breasts as much as you can while pumping. (Search "hands free pumping" online for devices that fit any brand of pump and allow you to double pump with both hands free.) Continue until milk flow slows to a trickle.

3. Massage your breasts again, concentrating on areas that feel full.

4. Finish by either hand expressing your milk into the pump's nipple tunnel or single pumping, whichever yields the most milk. Either way, during this step, do intensive breast compression on each breast, moving back and forth from breast to breast several times until you've drained both breasts as fully as possible.

This entire routine took the mothers in the study an average of about 25 minutes.

These two online videos demonstrate two different hand-expression techniques that can be used as part of hands-on pumping HERE and http://ammehjelpen.no/handmelking?id=907 (scroll down for the English version).

Hands-on pumping can be used by any mother who wants to improve her pumping milk yield or boost her milk production. Drained breasts make milk faster, and hands-on pumping helps drains your breasts more fully with each pumping.

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To Pump More Milk, Use Hands-On Pumping - Nancy Mohrbacher

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Would you like an effective method for pumping more milk? Until 2009, most of us assumed that when a mother used a breast pump, the pump should do all of the milk-removal work. But this changed when Jane Morton and her colleagues published a ground-breaking study in the Journal of Perinatology.

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There are several reasons milk supply may have to be established by expressing and not by directly breastfeeding. Mother and baby may have to be separated after birth due to prematurity or illness, or maybe baby just cannot latch on for some reason. Maybe baby is tongue tied, has a cleft palate or is too sleepy to feed effectively.

So how does a new mum start to establish a milk supply if she is not directly feeding her baby?

After birth you should be encouraged to hand express colostrum within an hour of birth if possible, or at least within the first 6 hours. Ask to be shown the technique by your midwife, or there are plenty of great video tutorials online. This one from Global Health Media is particularly good, click here. It is important to massage the whole breast and the nipple for a couple of minutes before starting. Hand expressing is recommended for the first two to three days until the milk begins to come in as colostrum is very thick and sticky and is in small quantities, so will get lost in a pump. However, if large quantities of colostrum are being expressed, you could move onto the pump earlier. Also there are settings on some hospital pumps designed for expressing colostrum and some mums respond better to this. The pump can also be used just for stimulation.

Babies only need a small quantity of colostrum, so every drop counts. These small drops can be sucked up with a syringe direct from the nipple or dripped into a small cup and then sucked into a syringe. This can then be given directly to the baby. You should be encouraged to hand express 8 to 10 times in 24 hours to mimic the baby's feeding patterns. This will give enough colostrum to feed and to prime the lactation sites so that you will have the greatest chance to make a full supply or as near as possible. Some mums do struggle to express any colostrum in the first few days. It does not mean it's not in the breast, we all start making colostrum in the second trimester of pregnancy, but it can be a bit challenging to get it out. If it is proving difficult then maybe ask about donor breast milk until your milk "comes in". Most mums find they can express mature breast milk much more easily.

Moving on to the pump. Milk begins to "come in" around 3 to 5 days after birth, a process called "lactogenesis II". It is triggered by the birth of the placenta and will happen whether a mum is breastfeeding, pumping or doing neither. Breast milk gradually changes from colostrum to mature milk over a number of days and volumes should begin to increase. Continuing to pump 8 to 10 times a day will help ensure you establish a full supply.
Top tips to establish a good supply!
Frequency - There really is no better way to get a full supply than to pump frequently; 8 to 10 times a day to begin with is essential. Some mums with large storage capacities may be able to drop a couple of sessions and continue to make enough milk, but for many frequency is the key. Expressing sessions do not need to be equally spaced. And if you miss one for some reason, try to shuffle up the others so you still get the same number over 24 hours.

Efficiency - Using a hospital grade pump is recommended. In hospital the staff should be able to provide one for you to use, normally in the pumping room, sometimes by baby's cot or incubator. Once discharged, hospital grade pumps can be hired either direct from the manufacturer or from a local pump agent. If baby is in NICU there is often a discount code.

Breast shell size - It is really important to get the pump's breast shell size correct. This will mean pumping should be comfortable and not cause any damage to the nipples, and it will also help maximise milk production. Just a note to say sometimes a pair of breasts need two different sized shells! And sometimes you need to change size as you go through your pumping journey as breast size changes. Nipple diameter is the key. Check your manufacturer's information on this and experiment a bit.

Power pumping - This mimics a baby's natural cluster feeding pattern and can help stimulate milk production. The pattern is as follows using a double pump: pump for 20 minutes, have a 10 minute rest, pump for 10 minutes, rest for 10 minutes and then pump for a further 10 minutes. This can be done once a day to help boost supply. If you are using a single pump then you can power pump by pumping 10 minutes on the left and then 10 minutes on the right, rest 5 minutes, pump 10 minutes on the left and 10 minutes on the right, rest for 5 minutes and then pump ten minutes on the left and 10 minutes on the right again.

Hands on pumping technique - This is a technique which incorporates massage, hand expressing and pumping all at the same time. Many have found that this can greatly increase output. For a more detailed explanation watch this video

Hand expressing - after the flow has slowed you could try finishing off by doing some hand expressing. Often a little more can be squeezed out by hand

A hands free pumping bra - This can make the above massage much easier, as you use the bra to hold the pump onto the breasts and so hands are free. It also means you can pump and do other things at the same time. This can be essential, especially if you have older children. You can buy them or make your own by cutting vertical slots in an old bra or sports bra where your nipples are, and you can insert the cones through the slits.

Warmth - Applying a warm compress just before you express can help the let-down reflex.

Skin to skin with baby - Skin to skin, or kangaroo care as it is often referred to, helps boost oxytocin and encourages the milk to flow. Oxytocin is one of the key hormones involved in the production of breast milk and, amongst other things, stimulates the let-down reflex, meaning milk flows more easily when pumping.

Look at baby - Photos, videos, pictures, pumping next to the cot, listening to your baby. All these remind the breasts what they are supposed to be doing! They also stimulate oxytocin and help with supply.

Latch baby - If baby is beginning to latch on to the breast, pumping straight afterwards can make it much easier for the milk to flow as the baby will have stimulated the let-down reflex.

Distraction - "A watched pot never boils". It's the same with pumping. If you watch what you get, you will likely not get so much. Distracting with listening to music, relaxation recordings, mindfulness, watching comedy, chatting to other mums or friends and family all have been shown to increase milk production. Stress can inhibit the let down reflex so these techniques can help keep you relaxed.

Eat and drink - Good for health and energy of the mother, not necessarily for milk production.

Rest - It is really essential for mums to rest. Yes we also want them to wake once or twice a night to pump, but getting a good amount of sleep is so important to cope with the stresses and strains that you feel when a baby who is latching. Get help with all the usual household chores, looking after older children and cooking. Mother the mother so the mother is able to mother the baby.

Galactagogues - There are many foods or medications out there which either have some scientific evidence behind them or have anecdotal evidence that they can increases milk production. However, none of these work unless the milk is being removed frequently from the breast. They are not a magic wand. For more info on galactagogues have a look at this link

It is important to look at 24 hour output, not necessarily what is expressed in each session. This is because there is often a wide variation in amounts from different times of day, and also each breast often gives a different amount. Over the first few weeks, we hope to see a gradual increase in volume in each 24 hour period.

Once babies are strong enough or well enough they should be able to move gradually on to breastfeeding directly. Make sure you seek some support from a trained breastfeeding specialist to help you achieve this.

Kathryn Stagg IBCLC 2018

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There are several reasons milk supply may have to be established by expressing and not by directly breastfeeding. Mother and baby may have to be separated after birth due to prematurity or illness, or maybe baby just cannot latch on for some reason. Maybe baby is tongue tied, has a cleft palate or is too...

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PACED BOTTLE FEEDING IS A METHOD OF FEEDING YOUR BABY THAT MIMICS BREASTFEEDING. AS THE NAME SUGGESTS, IT INVOLVES PACING YOUR FEEDINGS TO ALLOW BABY TO BE IN “CONTROL” OF, PROCESS, AND RECOGNIZE HIS OWN “SATIETY,” OR FEELING OF FULLNESS. BABY IS GOING TO EAT MORE SLOWLY AND WORK HARDER TO GET THE MILK (LIKE HE WOULD WITH BREAST-FEEDING) AS OPPOSED TO TYPICAL BOTTLE FEEDING.

How to Pace Feed.
1.Baby is sitting more upright

2.Caregiver tickles baby’s lips with bottle

3.Nipple is then put into baby’s mouth

4.The bottle is held horizontally, which slows the flow significantly

5.After 20–30 seconds of feeding, the bottle is tipped downward or removed from baby’s mouth to stop the flow of milk (creating a similar pattern as in breastfeeding)

Babies Position.
Hold baby in an upright position, as opposed to laying down. This helps baby to control the flow of milk better. He doesn’t have to be at an uncomfortable 90-degree angle, but only slightly reclined so that the bottle isn’t pouring down into baby’s mouth.

Offer the bottle horizontally.
Lay the bottle nipple across baby’s lips (nipple pointed up) when baby starts rooting and opening his mouth. Let baby draw the nipple into his mouth and close his lips on the base of the nipple. Baby essentially is going to “latch” on the bottle nipple like he would a breast.

Once he’s latched on, keep the bottle horizontal. This allows baby to control the flow of milk better. This also helps the bottle to last the entire length of a normal feeding, usually 10–20 minutes, rather than baby gulping a bottle down in 5 minutes. Baby learns to recognize when he’s full because he is not filling his belly before the signals of satiety can reach his brain.

You may also consider not allowing the milk to reach the nipple of the bottle for a few minutes while baby sucks. This mimics the letdown of breast-feeding and can help reduce the chances of nipple preference.

One caveat would be if you have a really fast letdown. If your baby only nurses for 5 minutes per feeding, holding bottle at a horizontal angle is not quite as important. And frankly, paced bottle feeding probably won’t be a necessity for you since your baby is already used to a fast flow.

PAUSING

Babies at the breast will pause and take breaks often throughout a feeding. Baby’s caregiver should encourage pausing while bottle-feeding as well. If baby gets tense or starts gulping, lean him forward to allow the milk to flow away from the nipple to give him a break. If he pauses on his own, great!

SWITCH SIDES

Just as mom does while breast-feeding, move baby from one side to the other halfway through the feeding. This helps baby avoid a side preference, and allows for new views and eye contact, which is excellent for his development.

ENDING THE FEEDING

One big drawback of bottle feeding is the risk of over-feeding. Look for cues that baby may be getting full, such as:

• Slower sucking

• Eyes wandering

• Falling asleep

• Hands are open and relaxed

When you think baby’s getting close to being full, remove the nipple from his mouth by gently twisting. Offer it again, and if he accepts, give him about 10 sucks, and repeat until he refuses. This will help teach him the feelings of satiety and reduce the chance of over-feeding.

Likewise, don’t coerce baby into drinking the last few drops of milk in the bottle. If he falls asleep, he is finished (an exception being newborns who may need to be awakened in the first few days to feed).

Benefits of paced bottle feeding

Breast-feeding is the biological design, so it makes sense that we would want to recreate this dynamic as best we can when bottle feeding. Paced bottle feeding has many benefits, which will help your child both in the short and long-term.

BABY AVOIDS BEING UNDER- OR OVER-FED

If the caregiver is in charge of when and how much baby eats, baby is not likely to get the correct amount of milk. Paced bottle feeding helps baby be in charge, just like when he’s at the breast.

LESS STRESSFUL FOR BABY

Babies can become very stressed when laid on their backs to eat from a bottle. When baby swallows milk from a bottle, the negative pressure forces more milk out of the bottle. Baby has to keep gulping to avoid choking. Paced feeding gives baby the time and space to eat at his or her own pace.

AVOID COLIC

Proper feeding techniques and a good bottle can minimize colic-like symptoms. When milk pours into baby’s mouth, as happens with conventional bottle feeding, baby gulps to keep up, ingesting air in the process, which can cause gas.

EASIER PUMPING FOR MUM

If baby is being over-fed, mom needs to continually pump extra milk to replace the milk that’s being fed. Sometimes this leads to mama believing she has low milk supply. When baby is in charge, it’s much more likely that the amount mom pumps is exactly what baby needs.

SUPPORTS BREAST-FEEDING RELATIONSHIP

Using a feeding technique that resembles breast-feeding is a great way to support the breast-feeding relationship and avoid a bottle preference. We are learning that babies don’t struggle as much with “nipple confusion” as with “flow preference.” If you are consistently giving a breast-fed baby fast-flowing bottles, they will probably prefer that easier, faster milk versus the breast.

MAY IMPROVE HEALTH LATER IN LIFE

One reason that breast-feeding is so great is that it allows baby to eat at his own pace, allowing him to learn his body’s cues for satiety. Studies have found that bottle feeding plays a large part in teaching overeating. Therefore, paced bottle feeding may contribute to healthier eating habits in the future.

WHICH IS THE BEST BOTTLE TO USE?

Some lactation consultants like a narrower nipple found in traditional bottles versus the more breast-like nipples on some bottles. They prefer this style because baby can “latch” deeply on the narrower nipple, like with a breast. Other lactation consultants say it isn’t the bottle that matters as much as the pace of milk flow.

I like the breast-shaped nippled bottles because they are almost always a slow-flow bottle and the baby has to work for the milk, regardless of how you hold it (horizontal or vertical). Here’s our post on the best bottles for breastfed babies.

WILL PACED BOTTLE FEEDING MAKE MY BABY GASSY?

When I first saw demos of this feeding method, I instantly thought of baby getting gassier. However, many lactation consultants say that air isn’t what causes gas. It’s more due to baby’s immature nervous and digestive systems.

If you notice an increase in gas, switch to a breast-shaped nipple bottle, which is slow flow. Also, try holding the bottle more horizontally so that less air interferes with the feeding.

Whether you’re going back to work full-time, part-time, are exclusively pumping, or feed formula, paced bottle feeding can be a great way to support yourself, and especially, your baby.

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Reposted from: Imagine a news story about a baby gorilla just born in London zoo:Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'. I have written elsewhere on the dangerous obsession of the infant feeding interval [4]. It's dangerous for both babies and mothers. But we need to remember breastfeeding isn't just about feeding and it never has been. https://growingfamilies.co.uk/blog/
"ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health" but days later it's reported that staff are concerned. Fumbi's mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She's losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn't feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin induced bonding that helps the formation of their early relationship. Fumbi is at risk.
Oh dear. Something seems to have happened to Fumbi's mother. We'd be worried.
A phrase most breastfeeding supporters would like to evaporate from the planet is, 'he is using me like a dummy'. No, dummies were invented partly because we forgot what breastfeeding was about. There's not enough evidence to say for certain how dummies impact on breastfeeding [5] but those of us who work with breastfeeding families can see how the sucking action and latching can sometimes shift when babies use dummies a lot and there can be issues when mums feed less and milk supply doesn't get the messages it needs.
Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin hormone (which is the hormone key in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing cortisol stress levels. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotional secure, growing brain connections, trying to get to sleep (which YES is one of the purposes of breastfeeding.)
If you just think breastfeeding is about food and calories (and "quick, measure the gap between breastfeeds!") you are doing a nature a huge disservice.
And you want to use an app on your phone to measure all those different reasons why a baby comes to the breast? You're measuring fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack, has a meal? You wouldn't find an app for that and if you did, it would probably flag you up as someone needing some urgent assistance.
Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby's needs in the way they are asking you to. Don't try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are routine person and you are struggling with a feeling of 'losing control', give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you'll have some options. Try and 'control' too early and you'll find things go out of your influence in ways you can't come back from easily.
Get help if things feel wrong- if breastfeeding hurts, if you're not sure about weight gain or nappies, if you can't work out how to meet your own needs for food and sleep. There are lots of people who will help out and we're at the end of a phone or a Twitter account or Facebook page. But don't confuse your baby behaving unexpectedly for something going 'wrong'. Maybe no one told you what normal would be.
If we let normal happen it WILL make all of your lives easier in the long term.
You're creating a little person who enters this world with their needs being met - we call it love.
​
Emma Pickett IBCLC
ABM Breastfeeding Counsellor
The ABM is kindly sponsoring Emma's session at Growing Families - http://abm.me.uk/
References:
However this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We're not designed to dump our babies and go off hunting and foraging for nuts. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us 'carry mammals'.
But instead we got the message somewhere that babies can be 'spoilt'. We are supposed to encourage them to be independent and sleep apart from us. We're meant to be able to put them down. If we can't put them down, if they want to sleep touching us, if we hold them when they sleep - we've apparently failed some test. Though it's not quite clear who the examiner is.
There are popular books that even use terms like 'accidental parenting' just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of 'advice' has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby's sleep by the clock and leave a baby only a few weeks old to cry if necessary.
What does your baby want?
They don't want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don't want to waste energy keeping warm and crying when they don't need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.
"My baby won't go down in its Moses basket". Yes, it's frustrating when you thought that was what they were 'supposed to do'. But would it feel easier if you knew that wasn't likely to be their first choice and there are good biological and evolutionary reasons for that?
"But I'm not going to get any sleep".
From the Infant Sleep Information Source [1]:
"70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart."
Research shows that these mums breastfeeding through the night (and mostly bed sharing) will ALSO be getting better quality sleep and be more rested than other parents [2] Good sleep is possible if we stop battling nature.
The book "Sweet Sleep: night time and naptime strategies for the breastfeeding family" is a great place to start. It talks to you about creating a safe space where everyone gets a better night's sleep.
A lot of your baby's urges are eminently sensible. If they don't want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.
Don't expect to be up and making a moussaka on day 5. The feeling that you 'shouldn't' be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren't supposed to change. Our commitment to work isn't supposed to change. Our ability to engage with political life and housework and social media isn't supposed to change. Actually, throughout much of human history, mum isn't going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn't have to be moussaka), sleeping and being with our new baby.

Emma Pickett IBCLC is leading our breakout session on Breastfeeding at "Growing Families: Facts, Fiction and Other Stuff" this October. It is a one-day event for all expectant and new families - mum, dad, grandma, grandad, aunts, uncles, supporters - and the professionals who work with them. This is a not-for-profit event, created by four mothers, two of whom are also healthcare professionals. Our mission is to tackle the postnatal information that desperately needs covering for new families. To explore expectations and evidence around the early days with baby. To keep ticket prices low, with no expectation of making a profit, in order to open up the event to as many people as we can. To ensure that support for the event comes from ethical organisations and those who share our interest in evidence based information and family well-being. To give new families the confidence to face the challenges ahead.
Please click here to book your place: https://growingfamilies.co.uk/prices-booking/
​
Here Emma tells us about what is actually "normal" when breastfeeding a newborn baby.

I've been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she's sounding desperate. Breastfeeding really matters to her and she wants it to work. She's overwhelmed and confused. The first voice we hear might sometimes be the partner's and a mum is too upset to even come to the phone.
Hundreds of these calls end with a contented calm voice saying, "Thank you. It's such a relief to know that's normal. I feel so much better now". As it happened, breastfeeding was actually going OK but it was her understanding of everything else that was confused. What she interpreted as a breastfeeding 'problem' was actually a new baby's normal and natural response to their new environment. She just didn't know how babies were 'supposed to behave'.
If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film - but instead of the ability to pilot helicopters or practise high level martial arts, you'd know about cluster feeding and a newborn's desire for closeness, nappies and normal fussiness.
The National Breastfeeding Helpline would be quieter overnight but we'd all feel a lot more relaxed and able to enjoy these teeny new people in our lives.
But actually... you've already had that download. You just may not have realised it. It's deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day 3 or how to correct a baby's latch without help but there's so much you do know. You probably didn't grow up surrounded by breastfeeding (as Elena Abell's recent blog highlighted) and for some aspects of breastfeeding you will need support and information, but there's a ton you do know about your baby: things that just feel right and things that don't.
And your baby had the download too. Sometimes it gets fuzzied with a birth that didn't go to plan but their instincts are in there too.
Two things that are normal:

They come to the breast for lots of different reasons and they usually have a good reason for doing so.

https://www.isisonline.org.uk/where_babies_sleep/parents_bed/

http://www.ncbi.nlm.nih.gov/pubmed/17700096

http://www.llli.org/sweetsleepbook

http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/the-dangerous-game-of-the-feeding-interval-obsession

http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Miscellaneous-illnesses/Review-of-dummy-use-and-its-potential-impact-on-breastfeeding/

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Category: Is THIS Normal? The First Week With A Breastfeeding Newborn

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Reposted from: Imagine a news story about a baby gorilla just born in London zoo:Just as parents feel they've failed if their baby doesn't sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast 'too much'.

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Oh, those sweet little newborn hands. Such a love/hate relationship we breastfeeding mothers have with those hands. We love to hold and kiss those sweet-smelling hands, yet when it's time to breastfeed, those annoying little clawing paws won't get out of the way! The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby's pecking mouth.
So, what's the deal with those hands? Why is it that immediately when our baby realizes he is starving, his hands get in the way?
Fun fact #1: Did you know that your baby has been using his hands in this fashion while in utero? Ultrasounds show babies bringing their hands to their faces before swallowing amniotic fluid. This is actually a process in the feeding pattern, which explains why babies bring their hands to their mouths when they are hungry.

Fun fact #2: Did you know that if your baby's face is not touching your breast as you initiate a breastfeeding session, he will use his hands to find your nipple? Newborns have incredibly poor eyesight and use all five senses to locate and latch on to the breast. Those little hands are searching for your breast to help bring it closer to his mouth.
So, what's a mom to do when her baby is crying to eat, yet his hands are blocking every chance she has to put her breast in the baby's mouth?

Let your baby suck on his fingers to calm himself at the breast. When he moves his hands, he is already at the 'restaurant' and will be ready to breastfeed.

Try not to tuck your baby's hands under his body or swaddle him while breastfeeding. Tucking his hands can disorient him. Think about if you were trying to eat with your hands tied behind your back. You would most likely feel off-centered and clumsy. Babies need their hands to keep them stable, just like we need our arms to our side or in front of us when we eat.

If you have sore nipples and the thought of your baby clawing them makes you yelp just thinking about it, then keep your baby's face touching your breast. Try laid-back breastfeeding to assist with this. In this position, you can wrap your baby's hands AROUND your breast and he will come in with his face instead.

Catherine Watson Genna, one of the most amazing lactation consultants I have ever met (and also the head researcher in an infant hand-use while latching study) recommends this technique in the Lactation Matters article, An Interview with Catherine Watson Genna, "Sometimes babies do get caught in a 'reflex loop' of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom's breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again." More information can be found in her article, Facilitating Autonomous Infant Hand Use During Breastfeeding

So, maybe those roaming little hands are actually helping our babies to become better breastfeeders. Who knew?

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Newborn Hands: Why are they always in the way while breastfeeding? - SDBFC

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Oh, those sweet little newborn hands. Such a love/hate relationship we breastfeeding mothers have with those hands. We love to hold and kiss those sweet-smelling hands, yet when it's time to breastfeed, those annoying little clawing paws won't get out of the way! The mi

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By Kelly Bonyata, BS, IBCLC
It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months.
My daughter had a fussy time every evening for a couple of months (yes, it does go away!). I spent weeks camped out on the end of the sofa with a constantly nursing and/or fussy baby every evening from about 6 to 10 PM. With my son, we didn't have the luxury of being able to sit down. Alex was unhappy and crying unless he was upright and being walked around at this time of day (and sometimes this only helped him to be less unhappy). He would occasionally have a very fussy time during the day, too. Nursing rarely helped to calm his fussiness (unlike with my daughter), so I usually didn't have that tool to work with (though I always tried). His fussiness was such that I looked into other causes (such as food sensitivity), but we never determined any reason for it and he was all smiles the rest of the time. The fussiness gradually went away between 3 and 4 months, as is the norm, but the first few months were hard. Nowadays, the typical comment that I hear about him is "Is he always this happy?" So remember: this, too, will pass...

Cluster feeding, also called bunch feeding, is when babies space feeding closer together at certain times of the day and go longer between feedings at other times. This is very common, and often occurs in the evenings. It's often -but not always- followed by a longer sleep period than usual: baby may be "tanking up" before a long sleep. For example, your baby may nurse every hour (or even constantly) between 6 and 10 PM, then have a longish stretch of sleep at night - baby may even sleep all night.

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Cluster feeding often coincides with your baby's . Baby will nurse a few minutes, pull off, fuss/cry, nurse a few minutes, pull off, fuss/cry... on and on... for hours. This can be VERY frustrating, and mom starts wondering if baby is getting enough milk, if something she is eating is bothering baby, if EVERYTHING she is doing is bothering baby... It can really ruin your confidence, particularly if there is someone else around asking the same questions (your mother, your husband, your mother-in-law).

This behavior is NORMAL! It has nothing to do with your breastmilk or your mothering. If baby is happy the rest of the day, and baby doesn't seem to be in pain (as with colic) during the fussy time - just keep trying to soothe your baby and don't beat yourself up about the cause. Let baby nurse as long and as often as he will. Recruit dad (or another helper) to bring you food/drink and fetch things (book/remote/phone/etc.) while you are nursing and holding baby.

Does this mean that baby needs more milk than I can provide?

No. Don't give baby a bottle - supplementation will only tell your body that you need LESS milk at this time, and that will not help matters. Also, keep in mind that formula fed babies experience fussy periods in the evening, too - fussy evenings are common for all young babies, no matter how they are fed. The Academy of Breastfeeding Medicine spells this out in their supplementary feeding guidelines:

There are common clinical situations where evaluation and breastfeeding management may be necessary, but supplementation is NOT INDICATED including... The infant who is fussy at night or constantly feeding for several hours.

Why do babies fuss in the evening?

One frequently-heard explanation for baby's fussiness in the evenings is that milk volume tends to be lower in the evening due to the natural cycling of hormones throughout the day. However, Dr. Peter Hartmann, a breastfeeding researcher, has said that in the women he has studied, milk volume is not low at this time of day. Even if milk volume is lower in the evening, fat content is typically higher in the evening (particularly if baby is allowed to control this via cue feeding), so the amount of calories that baby is getting should not be significantly different. Milk flow can be slower in the evening, which may be frustrating for some babies.

Doctors often attribute evening fussiness to baby's immature nervous system (and the fussiness does end as baby gets older, usually by 3-4 months). However, Dr. Katherine Dettwyler (who does research on breastfeeding in traditional societies) states that babies in Mali, West Africa and other traditional societies don't have colic or late afternoon/evening fussiness. These babies are carried all day and usually nurse several times each hour.

So perhaps none of these explanations is a complete answer to baby's evening fussiness. For many babies, the fussy time seems to be characterized by a need to have small quantities of milk at frequent intervals, combined with lots of holding, cuddling and movement. Babies who are offered as much expressed milk or formula as they will take by bottle [note: this practice will decrease your milk supply!] often behave in exactly the same way in the evenings. Baby takes a small amount and dozes (and fusses), then a little more, and so on. Perhaps babies "remember" mom being very active during her pregnancy at these times, and want to be held, rocked, and nurtured constantly again.
Perhaps babies simply need to nurse more often at this time - rather than consume more milk.
Soothing techniques for the fussy times

Wear baby in a sling or baby carrier. This will free one or both hands for other tasks (fixing dinner, caring for other children) while you hold, soothe and nurse your baby.

Change of pace. Let dad have some "baby time" while mom takes a shower or simply gets some time to herself to relax and regroup after a long day.

Go outside. Relax baby (and mom too) with a walk, or just sit and enjoy the outdoors. Try this a little before baby's regular fussy time.

Soothe with sound. Sing, hum, talk, murmur shhhh, listen to music, or use 'white noise.' Try different types of sound, different styles of music and singers with different types of voices.

Soothe with rhythmic motion. Walk, sway, bounce, dance, swing, or even try a car ride.

Soothe with touch. Hold or bathe baby, try baby massage.

Reduce stimulation. Dim lights, reduce noise, swaddle baby.

Vary nursing positions. Try side lying, lying on your back to nurse with baby tummy to tummy, etc.

Nurse in motion (while rocking, swaying, walking, etc.).

Combine rhythmic motion with soothing sounds.

Avoid scheduling, even more so in the fussy evening hours.

More soothing techniques.

More resources for fussy babies

@ KellyMom

@ other websites

Helpful books

The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Baby Sleep Longer
by Harvey Karp, MD

The Fussy Baby Book: Parenting Your High-Need Child From Birth to Age Five
by William Sears, MD and Martha Sears, RN, IBCLC

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Cluster Feeding and Fussy Evenings * KellyMom.com

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It is very common for babies to be fussy and nurse very often in the evenings, particularly in the early months. My daughter had a fussy time every evening for a couple of months (yes, it does go away!).

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After a few weeks or months, breastfeeding has often settled into an easy rhythm. But what if you're still dealing with a fussy breastfed baby or breastfeeding feels a struggle? Assuming any illness has been ruled out by your baby's doctor, contacting an IBCLC lactation consultant can help brainstorm why your baby seems unsettled at the breast at any age or stage. There are many possible reasons-from your baby having a sensitive personality or being easily distracted by the world around him, to being hungry and just needing more breast milk. Cows' milk allergy, reflux or temporary lactose intolerance could also be involved in unsettled behaviour as could sensory processing issues or high muscle tone. This article reviews some of the common causes of fussy, restless behaviour in a breastfed baby.

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#1 Positioning

Before looking for a more complicated reason, it can be helpful to rule out positioning or latch (the way a baby attaches to the breast) as a cause of fussy behaviour. If a baby feels unstable, has to turn their head into an awkward angle, or is prevented from using their feeding reflexes; they may find it difficult to latch and might cry or pull away from the breast. Conversely, when a baby feels stable and can use their feeding reflexes to help them, they will usually latch more deeply (take more breast tissue into the mouth as well as a nipple). A deeper, more stable latch helps babies control the flow and supply of milk from the breast more easily. For help with positioning see Breastfeeding Positions for Newborns, Latching Tips and Breastfeeding Videos. A breastfeeding specialist is the ideal partner to help with good positioning.

#2 Underweight or hungry baby

A restless baby who constantly feeds or has trouble sleeping may not be getting enough breast milk, especially if these behaviours are accompanied by poor weight gain (see Understanding Your Baby's Weight Chart). Dr Jack Newman, a Canadian paediatrician and breastfeeding expert, believes that the most common cause of fussiness at the breast is when a baby is frustrated with slow milk flow resulting in hungry babies who fuss, cry, pull at the breast or keep coming off the breast. Difficulty with driving the milk supply or with getting enough milk can be due to a poor latch, or poor positioning (see #1 above)-although there are other reasons for low milk supply.

Get skilled help

An IBCLC lactation consultant is the ideal specialist to help you identify the reasons for low milk supply or help identify other causes for fussy behaviour related to breastfeeding. For self-help with slow flow of breast milk, or low milk supply see How to Make More Breast Milk, Is My Baby Getting Enough Milk? and What is Breast Compression?

#3 Bottle preference or nipple confusion

If a baby has started to have quite a few bottles as replacement feeds whether with expressed breast milk or formula, some babies can seem to start to fuss at or turn away from the breast in preference for the bottle. This is sometimes called bottle preference or nipple confusion. Bottle preference is more likely to happen if a baby associates breastfeeding with frustration and slow milk flow but finds the bottle more rewarding, or if a baby has a lot of bottles before they have got the hang of breastfeeding. If your baby is having more and more bottles and is starting to seem grumpy or unsettled at the breast, options to try include:

#4 Normal behaviour mistaken for fussing

Sometimes what may seem like fussy or sensitive behaviour is normal baby behaviour. For example it is normal for a newborn baby to protest when they are put down; they love to be held and feel safest next to an adult body. It's normal for newborn babies to feed very frequently, they are doubling their weight in a matter of months! It's normal for an older baby to go through a phase of hating to be strapped in a car seat. The Womanly Art of Breastfeeding has several useful chapters on ages and stages which explain the normal behaviour of a breastfed baby as he grows. For example in the chapter "Six Weeks to Four Months: Hitting Your Stride" we are reminded that babies are individuals with different characters and with different needs:

Maybe you've got a sparkler - an intense, sensitive baby who needs input, input, input! His only settings are high and off. That's the downside. The upside is how truly bright and curious he is likely to become. You'll work hard as a mother to this baby. Look for other mothers of sparklers, to share notes with. Keep your sense of humour and try not to compare your busy days with those of your placid-baby friends. And keep your little sparkler close to you - your presence and touch will often go a long way toward calming him.

#5 Fussy baby at four months

If your baby has been breastfeeding well for several months but then becomes a fussy baby at four months (or five or six or older!) it can be puzzling to find a reason for the change. Around this age is a common time for babies to refuse some breastfeeds and become easily distracted with noises, activities, new surroundings and siblings-particularly during the day time. The Womanly Art of Breastfeeding calls this The Four-Month Fussies. It's a stage that will soon pass but you may need to remind your busy baby to breastfeed in the day and it may help to cut down on distractions at feed times such as closing the curtains to lower the lighting or putting subtitles on the television to reduce background noise.

#6 Allergies as a cause of fussy behaviour

Babies who are allergic to something from their mothers' diet passing into breast milk may appear unhappy at the breast-they might pull off and/or cry once milk starts to flow because it hurts their inflamed oesophagus (eosinophilic oesophagitis) or gives them tummy ache. They may prefer to breastfeed in unusual positions and may be very tense and seem to clamp down or bite the breast causing pain and sore nipples. They may have symptoms of reflux (#6) and/or tend to have very runny, copious and often green dirty nappies with symptoms of lactose overload (#7). Allergy is thought to be a possible cause of infant colic (unexplained crying). Author Maureen Minchin describes a characteristic set of allergy-related fussy behaviours including disturbed sleep, erratic and persistent crying:

[Babies] who are either hyperactive before [in the womb], and persistently miserable after birth, or

[Babies] who start screaming in the second or third week of life, and

[Babies] who give many indications of gut discomfort

[Babies] who progressively develop other minor symptoms, like night sweats, cradle cap, or patches of rough skin

[Babies] who do not respond more than briefly to mothercraft skills

See Milk Allergy in Babies for an in depth discussion of dairy or other allergies in breastfed babies.

#7 A fast let-down or too much milk

Some babies may find it difficult to cope with a very fast flow of milk causing them to cough, choke and constantly come on and off the breast. Babies have to coordinate sucking, swallowing and breathing during breastfeeding and, when the flow of milk is very fast, they may find feeding quite stressful causing them to be restless and keep releasing the breast to prioritise their breathing. Difficulty with controlling milk flow may be due to:

Suboptimal latch and positioning at the breast (#1). When baby's attachment is good they are better able to cope with the flow of milk even a fast let-down.

A baby who wants to continue to suck for comfort or to fall asleep after they are full, but the milk is flowing faster than they want (Newman, 2014)

Oversupply or "too much milk". Having plenty of milk is normally a good thing but sometimes the sheer volume of available milk can itself be a cause of unsettled behaviour or cause a temporary lactose overload with signs of discomfort and fussing (see #9 below). For more information see Oversupply of Breast Milk and What is a Fast Let-Down? Babies who are getting a lot of milk quickly may also spit up frequently (#8 below).

#8 Reflux

Spitting up some breast milk after a feed is quite normal or babies and most babies are "happy spitters". However if your baby has reflux and is very fractious and miserable-see Reflux in Newborns for more information. Reflux can be connected to allergy (#6 above) and too much milk (see #7).

Spitting up is a normal event for babies and doesn't usually cause them a problem although more severe forms are possible e.g. GORD or GERD [gastroesophageal reflux disease]. Certain underlying causes such as allergy or oversupply can make reflux worse. Working with an IBCLC lactation consultant alongside your health professional can help find ways to reduce reflux or identify other possible reasons for an otherwise healthy breastfed baby to be miserable and fussy.

#9 Lactose overload

Lactose is the main sugar in breast milk. If lactose is prevented from being digested properly in the intestines it could cause a temporary lactose overload. This might happen if there was any damage to the special cells in the intestinal wall that produce the enzyme that digests lactose, or if the volume of low fat breast milk passing through the intestines overwhelms the available enzyme. An overload of lactose might cause a baby to be unsettled and have tummy ache, wind (farts) and lots of frothy copious green poop. Lactose overload can be caused by/associated with cows' milk allergy (#6 above) and may be one explanation for infant colic. For more information and how to resolve it see Lactose Intolerance in Babies.

#10 Not enough sensory input or physical contact

Sensory deprivation or lack of physical contact can cause a baby to be fractious. Jack Newman attributes this to a fear of "spoiling" a baby and he calls it the English Nanny Approach;

Babies cry for many reasons-it is the only way they have to communicate their needs. Many people believe that if you pick up or otherwise respond to a baby who cries, he will cry more and more; if you ignore his cries, he'll stop. But research has shown just the opposite. The babies who are responded to most quickly and consistently cry less by the time they are a year old. Even more importantly, they tend to talk earlier and make more efforts to communicate, apparently because they have learned they will be listened to.

Most babies crave physical contact; carrying them in a sling and accepting they need to be with you much of the time can help to meet their need for closeness. Babies enjoy and need a variety of sensory experiences and being confined to a low sensory environment in the home can create unsettled behaviour. For some babies the opposite-over stimulation-might create an unhappy baby (#11).

#11 Sensory processing or high muscle tone

Some babies may have sensory processing issues, or high muscle tone that may contribute to intense and unsettled behaviour. Reading the linked articles may help to discover whether any of these could be an issue for your baby and what to do.

#12 Other causes of a fussy baby

Other ideas that may explain unhappy or restless behaviour could include minor dehydration (let your baby breastfeed frequently to quench his thirst), baby being too hot, too cold, being smoked over, wearing an overly tight nappy, having sore skin from an allergy, having sore gums from teething or thrush or being poorly e.g. having an ear infection.

Medications

Parents may notice a connection between their baby's behaviour and certain supplements or medications they take themselves or their baby takes. Fenugreek can affect some nurslings if the mother takes medicinal doses for her milk supply while vitamins or iron supplements can affect others causing discomfort.

Vaccinations

Some babies could be fussy if they have had a reaction to a recent vaccination. Parents can access patient information leaflets listing side effects for vaccines in the UK from the NHS Childhood Vaccines Timeline.

My older baby is still fussy!

Some of the ideas above might still be useful to problem solve the reasons for a fussy older baby, or you may enjoy reading The Fussy Baby Book by Dr William Sears which covers birth to five years. If the fussing is happening particularly at night you may find Baby Waking Up At Night or Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family helpful.

Summary

There are lots of reasons why a breastfed baby might sometimes seem unhappy or fussy such as being hungry, having allergies, sensory processing issues or lactose overload and more. Checking with your doctor will rule out a medical cause for your baby's unsettled behaviour and the best way to rule out any breastfeeding related reason is to contact a breastfeeding specialist to help you. More prolonged and persistent crying in breastfed babies is discussed in Colic and Breastfeeding.
* Extracts reproduced by permission from Pinter & Martin.

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After a few weeks or months, breastfeeding has often settled into an easy rhythm. But what if you're still dealing with a fussy breastfed baby or breastfeeding feels a struggle? Assuming any illness has been ruled out by your baby's doctor, contacting an IBCLC lactation consultant can help brainstorm why your baby seems unsettled at the breast at any age or stage.

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"He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on her play mat" "He hates going in his pram, he cries the second we put him in it".
If I had a pound every time I heard these from a new parent I'd be a very rich lady by now! What amazes me though is that society in general doesn't get it, they don't get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! We spend more than time though, the 'putting babies down' industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on..................having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn't enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn't consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak.
"Empathy: the intellectual identification with or vicarious experiencing ofthe feelings, thoughts, or attitudes of another."
To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world - but which world? The world they have spent most of their life in, their 'womb world' or the world they are in now - our world. To fully understand we must appreciate the enormous transition they have made - a concept known to many as 'The Fourth Trimester' -some make the womb to world transition easily, others less so and it is this latter group in particular "the clingy babies" we can learn so much from through this concept.
"Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to "behave." If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he's labeled an "easy baby"; if he does not adapt readily, he is labeled "difficult."" - Dr. William Sears.
So lets quickly compare the two different 'worlds' your baby has lived in:

Pretty different huh? On top of this the big thing to understand is that in utero the baby's world was constant, each day was the same, the stimulation didn't change, but now they are born each day is different - ever changing, ever stimulating!

The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help - but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally.

Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don't already know, you will soon learn what your baby likes best and that's what matters, that it is unique to *your* baby. Prescriptive 'do this/don't do this' baby calming lists don't help anybody - because they forget they are dealing with individuals - both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won't work, some you won't like - and that's OK! because really it isn't about these tips it's about you and your baby getting to know each other!
Movement
The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride.
Skin to Skin Contact
Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin - the love and bonding hormone - in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you.
Bed-Sharing
Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it's a subject that makes society very uncomfortable, but...it is an *amazing* baby calmer! It's really important that you think about how bedsharing will work and follow some important safety guidelines HERE.
Swaddling
Imagine how snug your baby was at the very end of your pregnancy inside of you - now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don't want to or indeed can't then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby's hunger cues if you are feeding on demand:

Never swaddle over your baby's head or near his face

Never swaddle your baby if he is ill or has a fever

Make sure your baby does not overheat and only swaddle with a breathable/thin fabric

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

Do not swaddle tightly around your baby's hips and legs, his legs should be free to "froggy up" into a typical newborn position.

Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before.

** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Babywearing
Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of "quiet alertness" - a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us - yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands!

Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby's spine whilst not placing any pressure on your baby's growing hips - newborns should always be carried facing inwards with a "frog leg" pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an 'in arms' position - i.e: how your baby would be held if you were holding them! This great picture from JePorteMonBebe highlights this newborn hold position perfectly.

Babywearing is a great way for dads to bond with babies!

It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling - it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up:
Position
The "tiger in the tree" position below, taken from baby yoga, is often magical, stopping a crying baby in an instant!

Noise
Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A special white noise recording, such as , can be played on loop whilst your baby sleeps to help keep them calm.
Feed
If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine - whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby's skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier.
Deep Bathing
The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby's tears in seconds - even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer.
Outside
If all else fails many babies stop crying the minute they hit the open air - I'm not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air - but it works!
What have you found calms your newborn? The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"My baby is only happy in my arms, the minute I put her down she cries" "He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on ...

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Unicef UK Baby Friendly Initiative | Hand expression

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Antenatal hand expressing colostrum - short guide

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Every mother should learn to hand express milk. Here are some resources for learning this useful skill.

Hand expression By Nancy Mohrbacher, IBCLC, FILCA

The Power of Hand Expression by Diana West, BA, IBCLC

Hand Expression of Breastmilk - a great video from the Stanford School of Medicine Newborn Nursery at LPCH

The basics of breast massage and hand expression - another great video by Maya Bolman, IBCLC and Ann Witt, MD, FABM, IBCLC

Hand Expression - This video is available in both Norwegian and English.

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Hand expressing your breastmilk * KellyMom.com

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Every mother should learn to hand express milk. Here are some resources for learning this useful skill.

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving you expressed colostrum may also be beneficial if your baby is likely to need special care after birth.

Breastmilk is a complete and perfect food for your baby. If the unexpected happens and you and your baby are separated, or if your baby has feeding difficulties or health problems, you will find it easier to express your milk for your baby if you have practised beforehand.

Why express while pregnant?
When to express
Babies with cleft lip and/or palate
Mothers with diabetes
Planned caesarean
Other medical conditions
Talk to your midwife
Why hand express?
When baby arrives
Expressing during pregnancy

Why express while pregnant?

Being familiar with your breasts and how they work will give you confidence for after the birth.

You'll be able to express a small amount of colostrum onto your nipple if your baby needs encouragement to feed.

You'll be able to express colostrum for your baby if he has difficulty feeding or is cared for in the neonatal intensive care or special care baby unit.

Being able to hand express will help you avoid problems with engorgement and mastitis.

If your baby doesn't breastfeed well in the first few days, being able to hand express will help you:

Express your milk if needed.

Provide your own milk for your baby to prevent or treat conditions such as low blood sugar or jaundice.

Avoid the need to give infant formula.

When to express

You can start expressing in your third trimester with the support of your midwife.

Is it Safe
Don't worry - following the suggestions to express for a few minutes each day is unlikely to trigger labour. Check with your midwife if you are at risk for early labour. If you experience any uterus cramps when expressing, stop immediately and contact your midwife.

Special circumstances

Learning to hand express while pregnant, and collecting and saving the colostrum can be helpful in some special situations, including:

A baby with a cleft lip or palate

This is sometimes diagnosed during pregnancy. Babies with any form of cleft can find it harder to breastfeed. Breastfeeding is particularly important for the first six months as it helps protect these babies against ear and respiratory infections. When the cleft is repaired, your milk helps promote healing and protects your baby against hospital germs.

Mothers with diabetes

In the first 24 hours after birth, babies of diabetic mothers risk developing low blood sugar levels (hypoglycaemia). A baby needs colostrum to maintain his blood glucose levels. Exclusive breastfeeding has been shown to reduce the risk of a baby developing diabetes later in life.

Planned caesarean or induced birth

Consider expressing the day before birth so your milk is available if you and your baby are separated, especially if your baby will be born early.

Mothers with breast abnormalities or who have had breast surgery

Stored colostrum can be helpful if you encounter problems establishing milk production.

Other medical conditions

Some medical conditions may make it harder for you and your baby to establish breastfeeding. Or, if you need to start medications that are incompatible with breastfeeding immediately after birth, your saved colostrum can still be given to your baby.

Talk to your midwife

Some NHS hospital trusts already have policies in place for sharing information on antenatal expression. Your midwife and other members of your antenatal care team may have information to share on breast massage and how to hand express. They should also be able to give you small sterile bottles, syringes or other containers with identity labels in which to save your colostrum.

Do ask if the hospital has an Infant Feeding Specialist who will be well informed about breastfeeding and a source of support in those early days.

Why hand express?

Hand expression is the best way to express colostrum. It is simple to learn and gets easier with practice. You'll only be expressing small amounts of colostrum, so using a pump will be impractical and may not be as effective.

You may receive information and a demonstration on hand expression from your midwife. Hand Expression of Breastmilk gives information on an effective technique.

Antenatally, you'll only need to express for three to five minutes-just until you have a few drops of colostrum. It may not seem very much, but a baby's first feed is no more than a teaspoon of colostrum. By expressing up to three times in a day, you can express enough for a feed. With practice and regular stimulation, you'll be able to express more colostrum.
When you go into labour
Take your stored colostrum with you to the hospital in a cool bag. The hospital can arrange to keep your colostrum frozen, possibly in the special care baby unit. Make sure you or your birth partner makes a note of where it is stored and that details are in your notes.

If you and your baby are likely to have difficulties or be separated, one of the containers can be defrosted once you're close to birth. This is then ready for the first feed, if needed.

When baby arrives

Your baby will need to breastfeed at least 8-12 times in 24 hours. If, for any reason, you are separated or unable to breastfeed your colostrum can be defrosted if needed, one container at a time to avoid waste. Your colostrum can also be used if your baby needs supplements.

The first few days

Frequent breastfeeding and keeping your baby close by will help establish your milk supply and get breastfeeding off to a good start. If you and your baby are separated, express milk eight times in each 24 hours including once at night, until your baby is able to breastfeed.

Expressing as well as breastfeeding is important if your baby isn't feeding well, or needs supplements for any reason. This will help establish milk production and provide milk for your baby's next feed if needed. For any problems, seek skilled help from an LLL Leader with our list of local leaders

A handy technique

Hand expression is a useful technique to learn even though most mothers find they rarely need to express and store their milk.

Hand expression is effective, convenient and free. You may also find you can express more milk by combining hand expression with pumping than using just a pump.

Expressing during pregnancy

1 It helps to be warm and relaxed.
2 You could practise in the bath or shower at first. When you start collecting colostrum, express after a bath or shower.
3 Wash your hands.
4 Massage your breasts to help milk flow.
5 Hand express from both breasts. Take care NOT to cause pain or discomfort.
6 You are likely to see small droplets or drips of colostrum appear as you express. Express directly into the container so you save every precious drop. If you've been given syringes and find it difficult to collect your colostrum, express into a small clean container (eg cup) and draw the colostrum up into the syringe.

You can express up to three times in the same day.

If you plan to express again that day, store the syringe in the coldest part of the fridge. This is usually at the back.

Once you've expressed for the last time that day, seal the syringe in a bag. Label and date it before placing it in the freezer.

The colostrum could be kept in the fridge if you're going to be induced or have a planned caesarean section within a day or two. Fresh colostrum inhibits the growth of bacteria and can be safely refrigerated for 48 hours.

Written by Karen Butler, Sue Upstone & mothers of La Leche League GB.
Further Reading
Beginning Breastfeeding
Caesarean Birth and Breastfeeding
Comfortable Breastfeeding
Diabetes and Breastfeeding
Hand Expression of Breastmilk
Is My Baby Getting Enough Milk?
Jaundice in the Healthy Newborn
My Baby Won't Breastfeed
Sleepy Baby - Why and what to do

LLLI Stories
Cleft Lip & Palate Breastfeeding
Books
The Womanly Art of Breastfeeding LLLI. London: Pinter & Martin, 2010
Breastfeeding Answers Made Simple. Mohrbacher, N. Amarillo, Tx: Hale Publishing, 2010.

References
Cox, S. An ethical dilemma: should recommending antenatal expressing and storing of colostrum continue Breastfeeding Review 2010; 18(3):5-7.
Cox, S. Expressing and storing colostrum antenatally for use in the newborn period. Breastfeeding Review 14( 3):11-6.
Oscroft, R. Antenatal expression of colostrum. Pract Midwife 2001;4 ( 4): 32-5.
NICE Clinical Guideline 63: Diabetes in pregnancy management of diabetes and its complications from preconception to the postnatal period. National Collaborating Centre for Women's and Children's Health March 2008 (revised reprint July 2008)
Going Baby Friendly. UNICEF UK

This information is available to buy in printed form from the LLLGB Shop

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Antenatal Expression of Colostrum - La Leche League GB

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Mothers start to produce colostrum (early milk) while pregnant. Being able to express colostrum is a useful skill to have. Saving you expressed colostrum may also be beneficial if your baby is likely to need special care after birth. Breastmilk is a complete and perfect food for your baby.

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Getting a deeper latch with breast/chest shaping

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The videos and images on this site contain demonstrations of carefully evaluated techniques to enable successful breastfeeding for mother and child.

Thank you for using our materials and please provide feedback on anything that can be presented more clearly.

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The videos and images on this site contain demonstrations of carefully evaluated techniques to enable successful breastfeeding for mother and child. Thank you for using our materials and please provide feedback on anything that can be presented more clearly.

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Positions for Breastfeeding - Breastfeeding Series

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Attaching Your Baby at the Breast – Breastfeeding Series

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This can be used when baby find it hard to latch on. Breast shaping can be very effective. It’s important to remember to shape the breast as if baby was to eat a sandwich.

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This can be used if baby has a small mouth or they are find it hard fo latch on

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By Kelly Bonyata, BS, IBCLC

The First Week

How often should baby be nursing?

Frequent nursing encourages good milk supply and reduces engorgement. Aim for nursing at least 10 - 12 times per day (24 hours). You CAN'T nurse too often-you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)-don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy at first-wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing.

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Is baby getting enough milk?

Weight gain: Normal newborns may lose up to 7% of birth weight in the first few days. After mom's milk comes in, the average breastfed baby gains 6 oz/week (170 g/week). Take baby for a weight check at the end of the first week or beginning of the second week. Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: In the early days, baby typically has one dirty diaper for each day of life (1 on day one, 2 on day two...). After day 4, stools should be yellow and baby should have at least 3-4 stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often-this is normal, too. The normal stool of a breastfed baby is loose (soft to runny) and may be seedy or curdy.

Wet diapers: In the early days, baby typically has one wet diaper for each day of life (1 on day one, 2 on day two...). Once mom's milk comes in, expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet.

Breast changes

Your milk should start to " come in" (increase in quantity and change from colostrum to mature milk) between days 2 and 5. To minimize engorgement: nurse often, don't skip feedings (even at night), ensure good latch/positioning, and let baby finish the first breast before offering the other side. To decrease discomfort from engorgement, use cold and/or cabbage leaf compresses between feedings. If baby is having trouble latching due to engorgement, use reverse pressure softening or express milk until the nipple is soft, then try latching again.

Call your doctor, midwife and/or lactation consultant if:

Baby is having no wet or dirty diapers

Baby has dark colored urine after day 3(should be pale yellow to clear)

Baby has dark colored stools after day 4(should be mustard yellow, with no meconium)

Baby has fewer wet/soiled diapers or nurses less frequently than the goals listed here

Mom has symptoms of mastitis(sore breast with fever, chills, flu-like aching)

Weeks two through six

How often should baby be nursing?

Frequent nursing in the early weeks is important for establishing a good milk supply. Most newborns need to nurse 8 - 12+ times per day (24 hours). You CAN'T nurse too often-you CAN nurse too little.

Nurse at the first signs of hunger (stirring, rooting, hands in mouth)-don't wait until baby is crying. Allow baby unlimited time at the breast when sucking actively, then offer the second breast. Some newborns are excessively sleepy-wake baby to nurse if 2 hours (during the day) or 4 hours (at night) have passed without nursing. Once baby has established a good weight gain pattern, you can stop waking baby and nurse on baby's cues alone.

The following things are normal:

Frequent and/or long feedings.

Varying nursing pattern from day to day.

Cluster nursing (very frequent to constant nursing) for several hours-usually evenings-each day. This may coincide with the normal "fussy time" that most babies have in the early months.

Growth spurts, where baby nurses more often than usual for several days and may act very fussy. Common growth spurt times in the early weeks are the first few days at home, 7 - 10 days, 2 - 3 weeks and 4 - 6 weeks.

Is baby getting enough milk?

Weight gain: The average breastfed newborn gains 6 ounces/week (170 grams/week). Consult with baby's doctor and your lactation consultant if baby is not gaining as expected.

Dirty diapers: Expect 3-4+ stools daily that are the size of a US quarter (2.5 cm) or larger. Some babies stool every time they nurse, or even more often-this is normal, too. The normal stool of a breastfed baby is yellow and loose (soft to runny) and may be seedy or curdy. After 4 - 6 weeks, some babies stool less frequently, with stools as infrequent as one every 7-10 days. As long as baby is gaining well, this is normal.

Wet diapers: Expect 5-6+ wet diapers every 24 hours. To feel what a sufficiently wet diaper is like, pour 3 tablespoons (45 mL) of water into a clean diaper. A piece of tissue in a disposable diaper will help you determine if the diaper is wet. After 6 weeks, wet diapers may drop to 4-5/day but amount of urine will increase to 4-6+ tablespoons (60-90+ mL) as baby's bladder capacity grows.

Milk supply?

Some moms worry about milk supply. As long as baby is gaining well on mom's milk alone, then milk supply is good. Between weight checks, a sufficient number of wet and dirty diapers will indicate that baby is getting enough milk.
This information is also found as part of the professional Breastfeeding Logs.
Additional information

@
Breastfeeding Logs Hunger Cues - When do I feed baby? Resources: Is Baby Getting Enough Milk? Normal Growth of Breastfed Babies Breastfeeding Basics
Information is Your Ally in preparing to breastfeed: 10 Tips for Success by Eva Lyford
Tips for juggling a newborn and toddler Frequent Nursing
Worried about milk supply?
How does milk production work? Is your milk supply really low? My breasts feel empty! Has my milk supply decreased? How can I find help for my breastfeeding problem?
@ other websites

The Importance of Colostrum by Paula Yount

Baby Explains- Normal Newborn Behavior by Diana Cassar-Uhl, IBCLC

It's Not Just About Breastfeeding by Danielle Rigg, JD CLC

What is Normal? by Paula Yount

Breastfeeding as Baby Grows by Becky Flora, IBCLC

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Breastfeeding your newborn - what to expect in the early weeks * KellyMom.com

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Frequent nursing encourages good milk supply and reduces engorgement. Aim for breastfeeding at least 10 - 12 times per day (24 hours). You CAN'T breastfeed too often--you CAN breastfeed too little. Nurse at the first signs of hunger (stirring, rooting, hands in mouth)--don't wait until baby is crying.

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Feeding cues

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Poo chart.

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Nice deep latch

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These photos show an effect latch.
Babies are close to mum.
Chin is on the breast
A large gap between chin and babies chest
No twists or turns in the neck
Back, neck and shoulders all in a nice straight line